Provider Demographics
NPI:1811152630
Name:JETT, VICKI LYNN (PT)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:JETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:FINCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1 GARNET CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2114
Mailing Address - Country:US
Mailing Address - Phone:501-772-3573
Mailing Address - Fax:
Practice Address - Street 1:1 GARNET CT
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2114
Practice Address - Country:US
Practice Address - Phone:501-772-3573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist